There are over 480 natural components found within the Cannabis sativa plant. Sixty-six have been classified as “cannabinoids”, chemicals unique to the plant. The two most well-known and researched are tetrahydrocannabinol (THC) and cannabidiol (CBD). CBD, THC and other Cannabis compounds are believed to interact synergistically, creating an entourage or ensemble effect, so that the impact of the whole plant is greater than the sum of its parts.
PhytoCare Vermont suggests that every patient use the smallest amount possible to achieve the desired effect.
The dosage of clinical Cannabis depends upon the individual patient's needs and tolerance. It is important to read the label on your medicine to determine the potency of each strain. Proper dosage will also depend on your method of consumption (i.e. oral, smoke, vapor, etc.).
An experienced Cannabis smoker can titrate and regulate dose to obtain the desired acute effects and to minimize undesired effects. When patients smoke or vaporize Cannabis they can titrate their dose by inhalation. The medicinal constituents are absorbed in the lungs and proceed directly to the brain and general circulation, avoiding a first pass through the liver. Patients can ascertain the effectiveness of the medicine within just a minute or two. By waiting between inhalations, patients can achieve the maximum effect with the least possible side effects.
Oral ingestion of Cannabis has quite different pharmacokinetics than inhalation. The onset of action is delayed and titration of dosing can be more challenging. While edibles offer a healthy and effective alternative to smoking, it is important for patients to understand their tolerance. PhytoCare Vermont recommends the following dosage for edibles:
- New Consumer: 1-5mg THC
If you have never experimented with edibles you should start here. It is important to make sure your body can digest Cannabis comfortably.
- Occasional Consumer: 5-10mg THC
5-10mg THC is considered a single serving. Eating more than 10mg is not typically recommended.
- Frequent Consumer: 10-15mg THC
Reserved only for those with a high edible tolerance or patients with severe and chronic pain.
Safety and Efficacy of Cannabis
The safety profile of smoked Cannabis, based on the ratio of therapeutic to lethal dose, is excellent. There is no established lethal dose or record in the medical literature of a Cannabis-induced fatality. In contrast, many commonly prescribed and abused substances such as barbiturates, opiates, and benzodiazepines have a more narrow therapeutic window and can be lethal in overdose. Adverse effects of cannabis include anxiety attacks and cognitive impairment.
Dependence to cannabis has been reported in 9% of regular users, but withdrawal symptoms are mild and self-limiting. A 2012 study published in the Journal of the American Medical Association, a the leading biomedical journal, found that long-term exposure to cannabis smoke was not associated with adverse effects on pulmonary function, in a large cohort of over 5,000 men and women over a 20-year period.
Efficacy and Synthetic Cannabis
Cannabis has been used for medicinal properties for centuries, but a complicated federal approval process has limited modern research. The American College of Physicians has called for increased research into the therapeutic role of medical Cannabis, reclassification of the drug from the Schedule I level, and exemption from federal criminal prosecution for physicians who prescribe or dispense medical marijuana in accordance with state law.
Medical benefit for use of the synthetic marijuana extracts is well-established and less inhibited by regulations. In the human body, different cellular receptors exist that respond to different cannabinoid molecules; susceptibility varies among humans. The cannabinoid-1 (CB1) receptors may modulate psychoactive properties, while CB2 receptors may provide anti-inflammatory or regenerative benefits.
The synthetic delta-9-tetrahydrocannabinol (THC), dronabinol (trade name Marinol), was approved by the FDA in 1992, and the synthetic analog Nabilone was approved in 1985, for therapeutic uses as an antiemetic and as an adjunct analgesic for neuropathic pain.
Recent studies of the liquid marijuana extract Sativex, which contains a mixture of THC and cannabidiol (CBD), have lead to its approval in Canada, New Zealand, and several European countries. Phase III trials of Sativex for the treatment of pain associated with cancer are underway in the US.
There are many different ways to consume Cannabis other than smoking. Vaporizers are an increasingly popular alternative to smoking. Many patients prefer oral ingestion or topicals. Concentrates offer a potent medicine for patients with chronic and severe pain.
Smoking is the most expedient and common method of consumption. The effects of smoking are immediate and dosage can be controlled by the patient. An experienced Cannabis smoker can titrate and regulate dose to obtain the desired acute effects and to minimize undesired effects.
Cannabis vaporizers are an increasingly popular alternative to smoking. A vaporizer is a device that gently heats up Cannabis at a lower temperature, achieved with digital accuracy, releasing the active medicinal components of marijuana while producing fewer harmful byproducts. A vaporizer heats the Cannabis plant material slowly causing the active ingredients to evaporate into a vapor without reaching the point of combustion. Inhalation of the vapor offers the same therapeutic benefits of smoking.
Oral ingestion of Cannabis has quite different pharmacokinetics than inhalation. The onset of action is delayed and titration of dosing is more difficult. While edibles offer a healthy and effective alternative to smoking, it is important for consumers to understand their tolerance. PhytoCare Vermont suggests starting with a low-dose, single serving (1-5mg) until patients understand how edibles will affect them.
Tinctures & Tonics
Cannabis can also be made into tinctures and tonics, which can then be added to food and liquids, applied on the skin, or consumed directly in small amounts by placing drops under the tongue. This is particularly useful when nausea and vomiting are present, such as when undergoing chemotherapy treatments. Tinctures and tonics are made by extracting Cannabis into a solvent such as glycerin or alcohol. As with edibles, it is best to start slow and use only a small dose until symptom relief is achieved.
Cannabis can also be applied directly onto the skin, with no psychoactive effect. Cannabis topicals, such as balms, salves, lotions, sprays and ointments can be very effective analgesics and anti-inflammatories. Cannabis topicals may provide symptom relief for arthritis, chapped skin, eczema, minor burns, muscle soreness, sunburns, swellings, joint pain, and tendonitis.
Hash & Concentrates
Concentrates are made by extracting the trichomes from the flowers of a female Cannabis plant. The extracts are processed into small blocks or oils which can then be eaten, smoked, or added to Cannabis-infused products. Concentrates have a much higher concentration of THC and other cannabinoids. Due to the high potency, they are not recommended for beginner consumers. PhytoCare Vermont offers hash, kief and CO2 extracted concentrate options.